Here are a couple abstracts on the topic. If...big IF...i have any handle on the cancer stem cell issue, there may be some concern that neo adjuvant chemo can stimulate them..might not be helpful in long run. I think it might depend on whether the chemo used addresses CSCs or simply reduces bulk tumor cells, triggering CSC repopulation down the road with potential steps toward resistance. I think neoadjuvant chemo can make node status a bit tricky to determine. I think back in '04 MD Anderson was doing trials with neo-adjuvant Adriamycin and Herceptin with tremendous shrinkage of tumors. Maybe by now they have better long-term info.
1: Expert Opin Pharmacother. 2009 Jun;10(9):1423-34.
Links
Neoadjuvant chemotherapy for early breast cancer.
Mieog JS,
van de Velde CJ.
Leiden University Medical Centre Department of Surgery, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
BACKGROUND: Neoadjuvant chemotherapy defines the preoperative administration of systemic therapy in order to downstage the primary tumor and affected lymph nodes to improve the surgical approach. Neoadjuvant chemotherapy is increasingly being used in the treatment of early operable breast cancer. OBJECTIVE: We reviewed the available data of neoadjuvant chemotherapy with emphasis on tumor response assessment and prediction, and locoregional management. METHODS: We searched the databases of MEDLINE and EMBASE using the search terms breast cancer, neoadjuvant or preoperative or primary or induction, and chemotherapy from 1950 to 1 March 2009. RESULTS/CONCLUSION: Compared with adjuvant chemotherapy, neoadjuvant chemotherapy increases breast conservation with equal survival and locoregional control. Tumor response assessment during neoadjuvant chemotherapy allows identification of in vivo tumor sensitivity to different agents which will help determine predictive factors for improved selection criteria. Randomized trials assessing the timing of sentinel lymph node biopsy in initially lymph node positive patients are warranted. In the near future, intraoperative fluorescent imaging and targeting of cancer stem cells will become important avenues of research.
1: Br J Cancer. 2006 Feb 27;94(4):524-31.
Links
Circulating endothelial cells and angiogenic serum factors during neoadjuvant chemotherapy of primary breast cancer.
Fürstenberger G,
von Moos R,
Lucas R,
Thürlimann B,
Senn HJ,
Hamacher J,
Boneberg EM.
Center for Tumor Detection and Prevention, Rorschacherstrasse 150, 9006 St Gallen, Switzerland.
gfuerstenberger@sg.zetup.ch
Circulating endothelial cells (CECs) as well as bone-marrow-derived endothelial precursor cells (EPC) play an important role in neovascularisation and tumour growth. To study the impact of neoadjuvant chemotherapy on the amounts of CEC and their precursor cells, mature CEC and their progenitors were quantified by flow cytometry in peripheral blood of breast cancer patients during anthracycline and/or taxane based neoadjuvant chemotherapy and subsequent surgery in comparison to age-matched healthy controls. Cell numbers were tested for correlation with serum levels of angiopoietin-2, erythropoietin, endostatin, endoglin, VEGF and sVCAM-1 as well as clinical and pathological features of breast cancer disease. Circulating endothelial cells were significantly elevated in breast cancer patients and decreased during chemotherapy, whereas EPC (CD34+/VEGFR-2+) as well as their progenitor cell population CD133+/CD34+ and the population of CD34+ stem cells increased. Concomitantly with the increase of progenitor cells an increase of VEGF, erythropoietin and angiopoietin-2 was observed. These data suggest that chemotherapy can only reduce the amounts of mature CEC, probably reflecting detached cells from tumour vessels, whereas the EPC and their progenitors are mobilised by chemotherapy. Since this mobilisation of EPC may contribute to tumour neovascularisation an early antiangiogenic therapy in combination with chemotherapy could be beneficial for the success of cancer therapy.
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